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A 33 year old female comes in to the ED with intermittent LLQ pain for the last 4 hours. She describes the pain as severe and intermittent pain, and has associated nausea and vomiting. She denies any other symptoms except chills and specifically has no history of diarrhea, constipation, rectal bleeding or vaginal bleeding. On exam, patient has LLQ tenderness which is more noticeable on pelvic exam than trans abdominal exam. You order labs which includes a normal metabolic panel, UA, CBC and also a negative pregnancy. She has marked improvement of her symptoms in the ED with pain control and a ultrasound you obtain shows: A right ovary which is 2.3 cm in size with normal flow. A left ovary which is 4.5 cm, which has flow on ultrasound, with surrounding fluid localized in the left adenexa. There is also a 2.5cm simple ovarian cyst on the left ovary. Which of the following is the most appropriate next step in management of this patient:A. Discharge this patient home if she is tolerating PO, has pain control and is stable as this represents a ruptured left adenexal cyst without complications.

B. Get a CT scan to ensure there is no mimic such as diverticulitis causing this patients LLQ pain.

C. Get an gynecology consult as the ultrasound findings show concerning findings for ovarian torsion.

D. Get a gynecology consult as the ultrasound findings are concerning for a ruptured ovarian cyst with free fluid and this patient will need serial exams and labs to ensure she does not have significant bleeding.

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